Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 1281 | MS |
Y | 111NR0400X | Rehabilitation Chiropractor | 1281 | MS |
NPI | 1174602577 |
---|---|
Provider Name | Dr. Diane Benizzi |
First Address | Ocean Springs, MS 39564-5016 |
Second Address | Ocean Springs, MS 39564-5016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2006 |
Last Update Date | 03/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U75789 | (02) | NJ |